Primary care patients’ experiences of video consultations for depression and anxiety: a qualitative interview study embedded in a randomized feasibility trial

Abstract

Background Integrated mental health care models that provide rapid access to video consultations with mental health specialists for primary care patients are a promising short-term, low-threshold treatment option and may reduce waiting times for specialist care. This qualitative study, nested within a randomized feasibility trial, aimed to explore participants’ views on this type of care model, its influence on the lived experience of patients, and barriers and facilitators for its delivery. Methods In five primary care practices, 50 adults with depression and/or anxiety were randomly assigned to either an integrated care model (maximum of five video consultations with a mental health specialist) or usual care (primary care or another treatment option). Prior to obtaining the trial results, interviews were held with participants who had received video consultations. Interviews were transcribed and analysed thematically. Results Twenty of the 23 patients who received video consultations participated in the interviews. Patients engaged well with the care model and reported positive effects on their most pressing needs, while denying safety concerns. Generally, they perceived the usability of video consultations as high, and temporary connectivity failures were not considered a substantial barrier. We identified two key mechanisms of impacts on the patients’ lived experience: fast access to specialist mental healthcare and the emerging rapport with the specialist. In particular, patients with no prior mental healthcare experience indicated that familiarity with the primary practice and their physician as a gatekeeper were important facilitators of proactive treatment. Conclusions From the patients’ perspective, mental health care models integrating video consultations with mental health specialists into primary care are linked to positive lived experiences. Our findings imply that primary care physicians should promote their role as gatekeepers to (1) actively engage patients, (2) apply integrated care models to provide a familiar and safe environment for conducting mental health care video consultations, and (3) be able to regularly assess whether certain patients need in-person services. Scaling up such models may be worthwhile in real-world service settings, where primary care physicians are faced with high workloads and limited specialist services. Trial registration DRKS00015812.

Curative care expenditure of outpatient anxiety disorder in Liaoning Province, 2015-2020-based on “System of Health Accounts 2011”

“…In the choice of institutions, the establishment of grass-roots first diagnosis, hierarchical diagnosis and treatment, two-way referral system of medical care, the first treatment at the grass-roots level, patients who meet the referral conditions are referred to higher-level institutions, and the medical insurance of patients who go beyond the level of treatment will not be reimbursed ( 52 ). For primary care institutions, the first step is to improve the psychiatric expertise, medication protocols, and basic cognitive-behavioral therapy knowledge of general practitioners; second, to discuss individualized treatment plans with the patient’s family members ( 89 ) and to provide routine psychoeducational and cognitive-behavioral interventions ( 53 ); furthermore, and then, to actively integrate video consultations with mental health specialists ( 90 ) to reduce the cost of patients’ medical care and the costs outside of the health insurance; Finally, increase primary diagnosis and care by primary care general practitioners; due to the strong emotional confusion and somatic symptoms of anxiety disorders, it is recommended to increase the proportion of primary care facilities less than 1 km away from the population, so as to provide patients with better access to general practitioners ( 52 ). Improve the basic drug system and increase the reimbursement ratio of anxiety disorder medication and psychological counseling, because anxiety disorder is a chronic disease that lasts for a long time, so that patients have the ability to afford the cost of anxiety disorder treatment on a continuous basis, which can improve the adherence of patients.…”

“…First of all, in order to enable residents to detect the disease early and receive professional treatment in hospitals at the first time, to reduce the public’s sense of shame from all angles, to guide patients to standardize their medical treatment, and to reduce the medical burden brought by deterioration of the disease, community general practitioners should strengthen the training of knowledge and skills of anxiety disorders and improve the attitude toward patients with anxiety disorders, and strengthen the preventive work, and psychiatrists should also give a certain degree of knowledge of anxiety disorders in the consultation, so that patients can rationally view anxiety disorders and seek medical treatment and prevention earlier. Psychiatrists should also provide some knowledge about anxiety disorders during consultation, so that patients can rationally view anxiety disorders and seek medical treatment and prevention at an earlier stage ( 90 ).…”